Continuation of the listing of the medical writings of Moses Maimonides commonly referred to as the Rambam.
10. “על בירור סימני ההתקפים”, Maqāla Fī Bayān al-Aʿrāḍ ; I have not come up with the name of this text that is essentially a translation of the original Arabic script. The Hebrew translation though seems to capture the intention of the Rambam. It too is difficult to render in English. It seems to be, “Clarifying the Symptoms of Outbursts”. The difficult word is “התקפים”. In Hebrew הֶתקֵף can mean attack, emotional fit, or time period. Rosner translates the title as, “The Causes of Symptoms”, and “Discourse on the Explanation of Fits”. Some translate the final word as “coincidences”. The meaning of the last word in Arabic is like the Hebrew word רעד which often means shaking or trembling. Latin translations mention “melancholica passione” say “suffering from depression”. Others mention “indiciis morborum” meaning the “signs of disease”.
The book does not mention the specific maladies that were afflicting the sultan. Although it is a separate work “The Causes of Symptoms” is often considered to be a companion to “The Regimen of Health”. The maladies mentioned in the latter are constipation, depression, bad thoughts, dread of death, and poor digestion. The former is a response to a letter from the sultan in which he details the painful incidents and his thoughts at the times they occurred. Encyclopedia.com states that this book was written for the sultan Afḍal Nūr al-Dīn Ali, who requested an explanation of the causes of his continued depression. Rosner adds hemorrhoids, weak heart, palpitations, and headaches.
Dr. Stephen A. Green calls this, “Maimonides’s primer for treating bipolar illness”. However the patient who is the subject of this treatise has not been struck with the extreme pervasive hysteria that characterizes hypomania. The sultan does have painful and debilitating emotional difficulties, but they are not sufficiently strong to constitute a psychosis. The idea of restoration of a healthy emotional state by means of discussion to resolve troubling issues, a healthy pleasant diet and environment, supportive people, and moderate use of sedatives and mood elevators seems to be valid; nevertheless to cure a psychosis in its root would be very difficult because of the intensity of the malady. I do believe that Maimonides could and did cure psychosis. However much of the cure had to do with the influence on the patient of his overwhelming righteousness and wisdom. In this way he was similar to a prophet, faith healer, or Talmudic sage.
Maimonides was interested in physical disorders that had a physical basis to them, for example snake bites and their cures. He also was interested in emotional and intellectual disorders which had a physical origin. He often takes the position that maladies, both emotional and physical, frequently are caused by some sort of moral failing and this was his primary interest.
“Clarifying the Symptoms of Outbursts” is mainly a review of the treatments that the sultan was receiving for his ailments. The first section deals with actively draining murky blood out of hemorrhoids, mainly by means of absorbent compresses and medicines. He explains that the problem with artificial drawing is that the veins become inflamed, blood flow can be excessive, and healthy blood will also be drawn out. However if it happens naturally the flow should not be blocked unless it becomes excessive. He comments that when nature opens the veins it does so to the extent that it is necessary and mainly the unhealthy substances leave. However when there is swelling and pain, then nature cannot open the veins and they should be opened manually.
In the second section the Rambam advocates a tonic of 35 grams of rose water, 70 grams oxtongue plant (lingua bovis) juice, and 28 grams of Syrian wine to improve the general condition of his patient. The pick-me-up is to be set aside of for ten hours before it is consumed. It should be taken several hours before meals and also some at bedtime. He praises drinking small amounts of wine because it assists digestion, facilitates the elimination of impurities through urination, and elevates the spirits. Mixing it with rose water, it broadens the spirit, invigorates the stomach, and adds to the advantages of wine. The oxtongue also improves the mood and eliminates the black bile which causes depression. The combination when taken at bed time makes for sound sleep, blots out disturbing thoughts, facilitates digestion and expulsion of wastes.
Other recommendations are regular bathing, messaging with violet oil, reduction in coitus, and physical exercise within proper limits. Another section discusses diet. One should regularly consume bread. The flour should not be soaked, rather it should be thoroughly sifted and preferably baked in an earthen oven. Light, white wine, good in taste is beneficial, but heavy red wines should never be drunk. Chicken is the ideal meat. It should be naturally fat and not force fed. A good recipe is to boil, stew, or steam it with fresh coriander and green fennel. He also recommends chicken recipes which include almonds, sugar, lemon juice, and wine. Another is raisins, almonds, and a little vinegar. There are seasonal variations for diet, but these are good for all times of the year.
Maimonides ends the book with a discussion of religion and medicine. He says that the harm and benefit of medical remedies is evident to the eye of the observer. However, the harm and benefit of religious commandments and prohibitions are not immediately discernable in this world.
Bibliography:
Encyclopedia.com; article on Maimonides, Moses
Rambam Maimonides Medical Journal, “Moses Maimonides: Biographic Outlines” by Fred Rosner, M.D., M.A.C.P.; http://www.rmmj.org.il/userimages/3/0/publishfiles/3article.pdf
Rosner, Dr. Fred; Maimonides Medical Writings (Volume 4) - Three Treatises on Health; published by The Maimonides Research Institute, Haifa, Israel.
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